Utilization of artificial intelligence in the diagnosis of pes planus and pes cavus with a smartphone camera

BACKGROUND

Pes planus (flatfoot) and pes cavus (high arch foot) are common foot deformities, often requiring clinical and radiographic assessment for diagnosis and potential subsequent management. Traditional diagnostic methods, while effective, pose limitations such as cost, radiation exposure, and accessibility, particularly in underserved areas.

AIM

To develop deep learning algorithms that detect and classify such deformities using smartphone cameras.

METHODS

An algorithm that integrated a deep convolutional neural network (CNN) into a smartphone camera was utilized to detect pes planus and pes cavus deformities. This case control study was conducted at a tertiary hospital with participants recruited from two orthopaedic foot and ankle clinics. The CNN was trained and tested using photographs of the medial aspect of participants’ feet, taken under standardized conditions. Participants included subjects with standard foot alignment, pes planus, or pes cavus determined by an expert clinician using the foot posture index. The model’s performance was assessed in comparison to clinical assessment and radiographic measurements, specifically lateral tarsal-first metatarsal angle and calcaneal inclination angle.

RESULTS

The CNN model demonstrated high accuracy in diagnosing both pes planus and pes cavus, with an optimized area under the curve of 0.90 for pes planus and 0.90 for pes cavus. It showed a specificity and sensitivity of 84% and 87% for pes planus detection, respectively; and 97% and 70% for pes cavus, respectively. The model’s prediction correlated moderately with radiographic lateral Meary’s angle measurements, indicating the model’s excellent reliability in assessing food arch deformity (P < 0.05).

CONCLUSION

This study highlights the potential of using a smartphone-based CNN model as a screening tool that is reliable and accessible for the detection of pes planus and pes cavus deformities, which is especially beneficial for underserved communities and patients with pain generated by subtle foot arch deformities.

Femoral nerve palsy following Girdlestone resection arthroplasty: An observational cadaveric study

BACKGROUND

When patients with a failed hip arthroplasty are unsuitable for reimplantation, Girdlestone resection arthroplasty (GRA) is a viable treatment option. We report on a patient who was treated with a GRA due to a periprosthetic infection. We discovered partial paralysis of the quadriceps muscle in this patient. We investigated the femoral nerve anatomy, particularly the nerve entry points, to better understand this phenomenon.

AIM

To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.

METHODS

Eight cadaveric hemipelves were investigated. The branches of the femoral nerve were dissected and traced distally. The GRA was performed by the direct anterior approach. Axial stress to the lower extremity was applied, and the relative movement of the femur was recorded. The femoral nerve and its entry points were assessed.

RESULTS

GRA led to a 3.8 cm shift of the femur in vertical direction, a 1.8 cm shift in the dorsal direction, and a 2.3 cm shift in the lateral direction. A 36.5° external shift was observed. This caused stress to the lateral division of the femoral nerve. We observed migration of the femoral nerve entry point at the following locations: (1) Vastus medialis (5.3 mm); (2) The medial part of the vastus intermedius (5.4 mm); (3) The lateral part of the vastus intermedius (16.3 mm); (4) Rectus femoris (23.1 mm); (5) Tensor vastus intermedius (30.8 mm); and (6) Vastus lateralis (28.8 mm).

CONCLUSION

Migration of the femur after GRA altered the anatomy of the femoral nerve. Stress occurred at the lateral nerve division leading to poor functional results.

Construction and validation of a risk prediction model for depressive symptoms in a middle-aged and elderly arthritis population

BACKGROUND

Arthritis is a prevalent and debilitating condition that affects a significant proportion of middle-aged and older adults worldwide. Characterized by chronic pain, inflammation, and joint dysfunction, arthritis can severely impact physical function, quality of life, and mental health. The overall burden of arthritis is further compounded in this population due to its frequent association with depression. As the global population both the prevalence and severity of arthritis are anticipated to increase.

AIM

To investigate depressive symptoms in the middle-aged and elderly arthritic population in China, a risk prediction model was constructed, and its effectiveness was validated.

METHODS

Using the China Health and Retirement Longitudinal Study 2018 data on middle-aged and elderly arthritic individuals, the population was randomly divided into a training set (n = 4349) and a validation set (n = 1862) at a 7:3 ratio. Based on 10-fold cross-validation, least absolute shrinkage and selection regression was used to screen the model for the best predictor variables. Logistic regression was used to construct the nomogram model. Subject receiver operating characteristic and calibration curves were used to determine model differentiation and accuracy. Decision curve analysis was used to assess the net clinical benefit.

RESULTS

The prevalence of depressive symptoms in the middle-aged and elderly arthritis population in China was 47.1%, multifactorial logistic regression analyses revealed that gender, age, number of chronic diseases, number of pain sites, nighttime sleep time, education, audiological status, health status, and place of residence were all predictors of depressive symptoms. The area under the curve values for the training and validation sets were 0.740 (95% confidence interval: 0.726-0.755) and 0.731 (95% confidence interval: 0.709-0.754), respectively, indicating good model differentiation. The calibration curves demonstrated good prediction accuracy, and the decision curve analysis curves demonstrated good clinical utility.

CONCLUSION

The risk prediction model developed in this study has strong predictive performance and is useful for screening and assessing depression symptoms in middle-aged and elderly arthritis patients.

Regulatory gaps in India’s medical device framework: The case of Johnson and Johnson’s faulty hip implants

The Johnson and Johnson faulty hip implant case represents one of the most significant crises in medical device history, impacting nearly 93000 patients worldwide. In response to alarming failure rates and a global recall in August 2010, countries such as Australia, the United States, and the United Kingdom quickly implemented revision surgeries and reimbursement programs to protect patient safety. In stark contrast, India's response was alarmingly delayed; defective implants continued to be sold even after the global recall. By the time the import license was revoked, and the Central Drugs Standard Control Organization issued a recall notice, these implants had already been involved in 4700 surgeries across India. This paper explores the systemic weaknesses in India’s medical device regulatory framework that contributed to this delayed action, resulting in many patients suffering from serious health complications. It highlights deficiencies in monitoring and reporting mechanisms, inadequate regulatory oversight, and insufficient approval processes. Furthermore, the inability to trace affected patients and provide necessary compensation underscores significant gaps in regulation. Although subsequent legislative reforms were introduced, this paper argues that substantial loopholes remain, posing risks for future incidents. Thus, urgent, comprehensive, and enforceable regulatory measures are needed to increase patient safety.

Prognostic factors in patients with bone metastasis of lung cancer after immune checkpoint inhibitors: A retrospective study

BACKGROUND

Accurate data on the prognosis of bone metastases are necessary for appropriate treatment. Immune checkpoint inhibitors (ICIs) are widely used in the treatment of gene mutation-negative non-small cell lung cancer (GMN-NSCLC).

AIM

To investigate the prognostic factors in patients with bone metastases from GMN-NSCLC following ICI use.

METHODS

This retrospective cohort study included 45 patients with GMN-NSCLC who were treated for bone metastases from 2017 to 2022 and received chemotherapy after diagnosis. Using Kaplan–Meier curves and Cox proportional hazards models, we evaluated the association between overall survival (OS) and clinical parameters, including serum biochemical concentrations and blood cell count.

RESULTS

Univariate analysis showed that Eastern Cooperative Oncology Group performance status ≤ 1 and the use of ICIs and bone-modifying agents after bone metastasis diagnosis were significantly associated with a favorable OS. Multivariate analysis revealed that ICI use after bone metastasis diagnosis was significantly associated with a favorable OS.

CONCLUSION

ICI use after bone metastasis diagnosis may be a favorable prognostic factor in patients with bone metastases of GMN-NSCLC. Consideration of ICI treatment for bone metastasis and GMN-NSCLC is warranted to establish a more accurate predictive nomogram for patients with bone metastasis.

Cervical spine infection arising from chronic paronychia: A case report and review of literature

BACKGROUND

Cervical spine pyogenic infection (CSPI) is a rare and challenging form of spinal infection that is typically caused by pyogenic bacteria and primarily affects the cervical vertebral bodies and surrounding tissues. Given its nonspecific symptoms, such as fever and neck pain, early diagnosis is crucial to prevent severe complications, including spinal cord injury. We report a previously unreported case of acute CSPI arising from chronic paronychia, exploring its diagnostic and therapeutic challenges through a review of the current literature.

CASE SUMMARY

The presented case involved a 15-year-old man with CSPI caused by Staphylococcus aureus, which led to complications including bacteremia and a paronychia-associated abscess. Acute pyogenic infection was initially diagnosed by typical symptoms and blood culture. Fever improved after antibiotic treatment while developing progressive limbs dysfunction. Six days after admission, the patient underwent anterior cervical debridement + autogenous iliac bone graft fusion + plate internal fixation and received 12 weeks of antibiotic treatment after the operation. Re-examination 3 years postoperatively showed that the patient had stable cervical fixation, no significant neck pain or upper limb abnormalities, and normal urinary function.

CONCLUSION

Early imaging findings, laboratory markers, and timely antibiotic treatment are crucial for CSPI management, preventing complications and facilitating recovery.

Gut microbiome and orthopaedic health: Bridging the divide between digestion and bone integrity

The gut microbiome, a complex ecosystem of microorganisms in the digestive tract, has emerged as a critical factor in human health, influencing metabolic, immune, and neurological functions. This review explores the connection between the gut microbiome and orthopedic health, examining how gut microbes impact bone density, joint integrity, and skeletal health. It highlights mechanisms linking gut dysbiosis to inflammation in conditions such as rheumatoid arthritis and osteoarthritis, suggesting microbiome modulation as a potential therapeutic strategy. Key findings include the microbiome's role in bone metabolism through hormone regulation and production of short-chain fatty acids, crucial for mineral absorption. The review also considers the effects of diet, probiotics, and fecal microbiota transplantation on gut microbiome composition and their implications for orthopedic health. While promising, challenges in translating microbiome research into clinical practice persist, necessitating further exploration and ethical consideration of microbiome-based therapies. This interdisciplinary research aims to link digestive health with musculoskeletal integrity, offering new insights into the prevention and management of bone and joint diseases.

Specific approach to total hip arthroplasty in patients with childhood hip disorders sequelae

Hip arthroplasty in patients with a history of paediatric hip disorders presents a significant challenge for orthopaedic surgeons. These patients are typically younger and have greater functional demands. Therefore, achieving optimal biomechanical conditions is crucial, involving placement of the acetabulum at the ideal centre of rotation and securing a stable femoral component with good offset to preserve abductor muscle function and restore leg length. The altered anatomy in these cases makes total hip arthroplasty more complex, necessitating thorough preoperative imaging and an individualised surgical approach. Various techniques may be employed to optimise biomechanical outcomes. We propose a modified lateral hip approach, offering exceptional visualisation of the acetabulum and femur while preserving the continuity of the abductor muscles without requiring trochanteric osteotomy. To achieve the most biomechanically advantageous acetabular position, cotyloplasty is our preferred method.

Enhanced recovery after surgery protocols for minimally invasive treatment of Achilles tendon rupture: Prospective single-center randomized study

BACKGROUND

Achilles tendon rupture is a common orthopedic injury, with an annual incidence of 11-37 per 100000 people, significantly impacting daily life. Minimally invasive surgery, increasingly favored for its reduced risks and comparable fixation strength to open surgery, addresses these challenges. Despite advantages like accelerated recovery, perioperative care poses emotional support, pain management, and rehabilitation challenges, impacting treatment efficacy and patient experience. To address these gaps, this study investigated the efficacy of a rapid rehabilitation protocol in enhancing recovery outcomes for minimally invasive Achilles tendon surgery, aiming to develop personalized, standardized care guidelines for broader implementation.

AIM

To evaluate a nursing-led rapid rehabilitation program for minimally invasive Achilles tendon repair surgery, providing evidence-based early recovery indicators.

METHODS

This study enrolled 160 patients undergoing channel-assisted minimally invasive Achilles tendon repair randomized into experimental and control groups. The experimental group received perioperative rapid rehabilitation nursing care, while the control group received standard care. The primary outcome measure was the Oswestry disability index score, with secondary outcomes including quality of life, Barthel index, patient satisfaction with nursing, incidence of complications, and rehabilitation adherence. Statistical analysis included appropriate methods to compare outcomes between groups. The study was conducted in a specific setting, utilizing a randomized controlled trial design.

RESULTS

All 160 patients completed the follow-up. The experimental group showed significantly greater improvements in key efficacy indicators: Postoperative Oswestry disability index score (8.688 vs 18.88, P < 0.0001), quality of life score (53.25 vs 38.99, P < 0.0001), and Barthel index (70.44 vs 51.63, P < 0.0001). The experimental group had a lower incidence of deep vein thrombosis (1.25% vs 10.00%, P = 0.0339) with a relative risk of 0.1250 (95% confidence interval: 0.02050-0.7421). Infection rates were lower in the experimental group (2.50% vs 11.25%, P = 0.0564). Hospital stay (5.40 days vs 7.26 days, P < 0.0001) and postoperative bed rest (3.34 days vs 5.42 days, P < 0.0001) were significantly shorter. Patient satisfaction was 100% in the experimental group vs 87.50% in the control group (P = 0.0031).

CONCLUSION

The rapid rehabilitation intervention significantly reduced pain, shortened hospital stays, and lowered complication rates, improving joint function and patient satisfaction.

Ipsilateral Rockwood type V acromioclavicular joint dislocation and midshaft clavicle fracture: A case report

BACKGROUND

Clavicle fractures are among the most common fractures seen in the emergency department. While acromioclavicular (AC) joint injuries are much less common. However, ipsilateral combinations of these injuries are quite rare with only a few cases reported in the literature.

CASE SUMMARY

A 29-year-old man who sustained a combination of ipsilateral AC joint dislocation and midshaft clavicle fracture. He underwent open reduction and plate fixation of the clavicle fracture, as well as semi-rigid surgical implants used to restore both the AC ligaments and the coracoclavicular joint. one year follow-up revealed that the patient had a complete range of motion and excellent shoulder scores. This case presents a rare presentation of such combination of injuries, contributing valuable insights to the literature on such rare injuries.

CONCLUSION

Combined midshaft clavicle fractures and AC joint dislocations are considered quite rare. Timely diagnosis of such injuries leads to great functional outcomes. AC joint dislocation should be suspected with midshaft clavicle fractures and should be investigated radiologically and clinically in an appropriate manner. Still, there is no consensus on the optimal management of such injuries.

Assessing clinical and patient reported outcomes of Sironix suture anchors in rotator cuff and Bankart repair surgeries

BACKGROUND

Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life. Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function and reducing pain. Recent advancements include new suture anchor technologies, such as the Sironix suture anchor known for its biomechanical strength and promising outcomes. However, there are limited real-world data on its effectiveness and safety, particularly in the Indian population.

AIM

To evaluate the effectiveness and safety of Sironix suture anchors in rotator cuff and Bankart repair surgeries.

METHODS

Sixty participants underwent surgery between January 2021 and December 2022, and demographic data and postoperative outcomes were collected through retrospective reviews and telephonic interviews. Validated scales, including the PENN Shoulder Score (PSS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Single Assessment Numeric Evaluation (SANE), were utilized for assessment.

RESULTS

Treatment with Sironix suture anchor devices, including Ceptre Knotted UHMWPE Suture Titanium Anchor, Spyke Knotted UHMWPE Suture Peek Anchor, Stativ Knotted UHMWPE Suture Anchor, and Viplok Knotless Peek Screw Anchor with Titanium Tip, revealed no repair failures. Participants demonstrated high satisfaction and functional improvement, as evidenced by the mean Quick DASH score (32.01) and PSS (71.65) and the satisfactory SANE scores for both injured joints (74.33) and non-injured (83.67) shoulder joints.

CONCLUSION

The study yielded favorable outcomes for rotator cuff tear repair and Bankart repair. No repair failures were observed, supporting the safety and efficacy of these devices in shoulder injury management.

Total hip arthroplasty preoperative planning for childhood hip disorders' sequelae: Focus on developmental dysplasia of the hip

Developmental dysplasia of the hip (DDH) poses significant challenges in both childhood and adulthood, affecting up to 10 per 1000 live births in the United Kingdom and United States. While newborn screening aims to detect DDH early, missed diagnoses can lead to severe complications such as hip dysplasia and early onset osteoarthritis in adults. Treatment options range from less invasive procedures like hip-preserving surgery to more extensive interventions such as total hip arthroplasty (THA), depending on the severity of the condition. Preoperative planning plays a critical role in optimizing surgical outcomes for DDH patients undergoing THA. This includes accurate imaging modalities, precise measurement of acetabular bone stock, assessment of femoral head subluxation, and predicting prosthesis size and leg length discrepancy. Recent advancements artificial intelligence and machine learning offer promising tools to enhance preoperative planning accuracy. However, challenges remain in validating these technologies and integrating them into clinical practice. This editorial highlights the importance of ongoing research to refine preoperative strategies and improve outcomes in DDH management through evidence-based approaches and technological innovations.

Low back pain in China: Disease burden and bibliometric analysis

BACKGROUND

Low back pain has become a global problem. Since many traditional Chinese therapies are helpful for low back pain, the current status of low back pain in China may provide some insights to this issue.

AIM

To demonstrate the disease burden of low back pain in China and the response of Chinese scholars to this issue.

METHODS

The burden of low back pain in China was estimated using the Global Burden of Disease Study 2021 released by the American Institute for Health Metrics and Evaluation. The incidence, prevalence and disability-adjusted life years were analyzed. We also performed a bibliometric analysis to analyzed the publication trend, changes of cooperation models and research topics on low back pain.

RESULTS

Prevalence of low back pain increased from 69.61 million in 1990 to 102.96 million in 2021. New cases increased by a stunning 44.50 million in 2021. Low back pain led to an increase of 4.16 per 1000000 population in terms of disability-adjusted life years from 1990 to 2021. But the increase in China was slower than that of world average. As a response, publications of low back pain published by Chinese scholars were stably raised. From 1990 to 2023, domestic cooperation significantly increased, while international cooperation and no cooperation decreased. However, domestic cooperation decreased between 2021 and 2023. The number of studies on prevention and treatment of low back pain reduced from 1990 to 2023, while the mechanism, etiology and other aspects of low back pain augmented.

CONCLUSION

The burden of low back pain in China is heavy. Together with the government, Chinese institutions of medical science should do more in declining the impacts of low back pain.

Gene expression analysis of cytokines and MMPs in melatonin and rhBMP-2 enhanced bone remodeling

BACKGROUND

In the medical and dental fields, there is a need for studies of new therapeutic approaches for the treatment of bone defects that cause extensive bone loss. Melatonin may be an important endogenous biological factor for bone remodeling, and growth factors may enhance the repair process.

AIM

To evaluate the gene expression of cytokines (IL-1β, IL-6, IL-10 and TNF-α), markers of osteoclastogenesis (RANK, RANKL and OPG) and MMPs (MMP-1, MMP-2, MMP-8 and MMP-13) from the treatment of melatonin associated with an osteogenic membrane and rhBMP-2 on the recovery of a bone injury.

METHODS

Sixty-four rats were used and divided into 9 experimental groups and were formed according to the treatment carried out in the region of the bone lesion, which varied between the combination of 1, 10 and 100 μmol/L of melatonin. Gene Expression analysis was performed using real time-PCR by reading the concentration of total RNA and reverse transcription.

RESULTS

There were differences between groups when compared with clot or scaffold control, and improvement with a higher concentration of melatonin or rhBMP-2. The combination melatonin (1 µg) with 5 μg of rhBMP-2, using the guided bone regeneration technique, demonstrated some effects, albeit mild, on bone repair of critical bone defects.

CONCLUSION

This indicates that the approach for administering these substances needs to be reassessed, with the goal of ensuring their direct application to the affected area. Therefore, future research must be carried out, seeking to produce materials with these ideal characteristics.

Presentation and management outcome of foot drop with tibialis posterior tendon transfer

BACKGROUND

Foot drop causes considerable disability. The ankle-dorsiflexion is either weak or lost completely. Additionally, the ankle eversion and toe extensions are also impaired. This results in a high steppage gait while walking. Overall, the gait is awkward; there is greater energy consumption; increased proneness to sustain injury of the forefoot; and more frequent falling during walking.

AIM

To document the clinical and epidemiological profile of foot drop patients in our population and evaluate the outcome of tibialis posterior (TP) tendon transfer for restoring the lost dorsiflexion in foot drop.

METHODS

The study was carried out at the National Institute of Rehabilitation Medicine in Islamabad over a period of 7 years. It included patients of all sexes and ages who presented with foot drop and had no contraindications for the procedure of TP tendon transfer. Exclusion criteria were patients who had contraindications for the operation. For instance, paralyzed posterior leg compartment muscles, Achilles tendon contracture, stiff ankle or toes, unstable ankle joint, weak gastrocnemius and scarred skin spanning over the route of planned tendon transfer. Also, patients who had the foot drop as a result of disc prolapses or brain diseases were excluded. Convenience sampling technique was used. The circum-tibial route of TP tendon transfer was employed.

RESULTS

Out of 37 patients, 26 (70.27%) were males whereas 11 (29.72%) were females. The mean age was 22.59 ± 8.19 years. Among the underlying causes of foot drop, road traffic accidents constituted the most common cause, found among 20 (54.05%) patients. The share of complications included wound infections in 3 (8.10%) patients and hypertrophic scars in 2 (5.40%) patients. At 1-year postoperative follow-up visits, the outcome was excellent in 8 (21.62%), good in 20 (54.05%) and moderate in 9 (24.31%).

CONCLUSION

The majority of cases of foot drop resulted from road traffic accidents that directly involved the common peroneal nerve. TP tendon transfer through the circumtibial route was found to be an easily executed effective operation which restored good dorsiflexion of the ankle among the majority of patients.

Effectiveness of negative pressure wound therapy in complex surgical treatment of necrotizing fasciitis of the upper limb

BACKGROUND

Necrotizing fasciitis (NF) of the upper extremities is a severe surgical pathology, and the incidence of this disease has been steadily increasing in recent decades. Surgical treatment is accompanied by the formation of extensive wounds, which can be treated with significant difficulties. In recent years, negative pressure wound therapy (NPWT) has proven to be highly effective. It is also promising for the treatment of NF.

AIM

To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.

METHODS

The results of the treatment of 36 patients with NF of the upper extremities in two groups (NPWT group and control group; 2022-2023) were retrospectively analyzed. In the NPWT group, the NPWT method (120 mmHg; constant mode) was used after surgical treatment. The number of vacuum-assisted dressings in patients ranged from 1 to 3, depending on the dynamics of the wound process. The duration of fixation of one bandage was up to 2-3 d. In the control group, conventional methods of local wound treatment were used. The following indicators were analyzed: The treatment delay, the prevalence of inflammation, the microbial landscape, the number of debridements, the duration of wound preparation for surgical closure, and the nature of skin plastic surgery.

RESULTS

Most patients experienced a significant treatment delay [4 d, interquartile range (IQR): 2-7 d], which led to the spread of the pathological process to the forearm and shoulder. The most common pathogens were Staphylococcus aureus (14; 38.9%) and Streptococcus pyogenes (22; 61.1%). The average number of debridements per patient was 5 (IQR: 3-7), with no difference between groups. The average time to prepare wounds for surgical closure was 11 ± 4 d in the NPWT group and 29 ± 10 d (P = 0.00001) in the control group. In the NPWT group, the wounds were more often closed with local tissues (15; 83.3%), and in the control group, split-thickness skin grafts were more often used (4; 50%).

CONCLUSION

The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II. Multiple debridement procedures have become a feature of this disease treatment. The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure. Early closure of wounds allows for more frequent use of local tissue repair, which ensures better results. NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.

Artificial intelligence awareness and perceptions among pediatric orthopedic surgeons: A cross-sectional observational study

BACKGROUND

Artificial intelligence (AI) is a branch of computer science that allows machines to analyze large datasets, learn from patterns, and perform tasks that would otherwise require human intelligence and supervision. It is an emerging tool in pediatric orthopedic surgery, with various promising applications. An evaluation of the current awareness and perceptions among pediatric orthopedic surgeons is necessary to facilitate AI utilization and highlight possible areas of concern.

AIM

To assess the awareness and perceptions of AI among pediatric orthopedic surgeons.

METHODS

This cross-sectional observational study was conducted using a structured questionnaire designed using QuestionPro online survey software to collect quantitative and qualitative data. One hundred and twenty-eight pediatric orthopedic surgeons affiliated with two groups: Pediatric Orthopedic Chapter of Saudi Orthopedics Association and Middle East Pediatric Orthopedic Society in Gulf Cooperation Council Countries were surveyed.

RESULTS

The pediatric orthopedic surgeons surveyed had a low level of familiarity with AI, with more than 60% of respondents rating themselves as being slightly familiar or not at all familiar. The most positively rated aspect of AI applications for pediatric orthopedic surgery was their ability to save time and enhance productivity, with 61.97% agreeing or strongly agreeing, and only 4.23% disagreeing or strongly disagreeing. Our participants also placed a high priority on patient privacy and data security, with over 90% rating them as quite important or highly important. Additional bivariate analyses suggested that physicians with a higher awareness of AI also have a more positive perception.

CONCLUSION

Our study highlights a lack of familiarity among pediatric orthopedic surgeons towards AI, and suggests a need for enhanced education and regulatory frameworks to ensure the safe adoption of AI.

Arthroscopic synovectomy for synovial hyperplasia in chronic knee gouty arthritis: A case report

BACKGROUND

Chronic synovitis due to chronic knee gouty arthritis (KGA) resulting in synovial hyperplasia has not been documented in the current literature, and thus the optimal management for this condition remains unclear. This case report discusses a 34-year-old man with a history of chronic KGA who presented with recurrent knee effusion resulting from synovial hyperplasia.

CASE SUMMARY

A 34-year-old man presented to our outpatient clinic with a 5-year recurrent knee effusion and a history of chronic KGA. Symptoms persisted despite serial aspiration and urate-lowering medication (febuxostat 80 mg once daily) for 2 months. Diagnostic arthroscopy was performed due to the recalcitrant symptoms. Intraoperatively, tophi deposition and excessive thickening of the synovial membrane were observed. Synovial biopsy and partial synovectomy were performed, revealing chronic synovitis with synovial hyperplasia that was consistent with chronic KGA. At follow-up after 6 months, the patient reported no further episode of knee effusion.

CONCLUSION

Arthroscopic synovectomy for synovial hyperplasia in chronic KGA sufficiently eradicates the symptoms of recurrent knee effusion.

Ilizarov technique for treatment of a giant aneurysmal bone cyst at the distal femur: A case report

BACKGROUND

Aneurysmal bone cyst (ABC) is a benign cystic of unknown etiology, characterized by multiple chambers and a high recurrence rate. Current treatment options include vascular embolization, surgical excision, curettage with cavity filling, sclerosing agent injection into the cavity, radiotherapy, and systemic drug therapy. Among these, surgical excision and curettage are the preferred treatment modalities. However, when the cyst reaches a large size, extensive removal of diseased tissue during surgery can hinder bone healing. In our department, we treated a case of a large ABC at the distal end of the femur in a child using the Ilizarov technique. The tumor was completely excised, and reconstruction was achieved through autologous femoral bone transfer. The follow-up at two years post-surgery indicated good results without tumor recurrence, and the growth and development of the child were essentially unaffected.

CASE SUMMARY

An 11-year-old boy was presented with an accidental fracture of his right leg. Despite having been examined at other hospitals, he had not received treatment. Given the potential for significant bone defects and the difficulty of the surgery, our doctors opted to use the Ilizarov technique to minimize harm to the patient. Upon admission, the patient underwent a needle biopsy and complete tumor resection-the Ilizarov technique assisted in the transport and reconstruction of the autologous femoral bone. Postoperatively, the patient exhibited regular follow-ups, during which bone transport was gradually performed, and the external fixation frame was removed on time. Follow-up X-rays of the right lower limb displayed no tumor recurrence, with a normal appearance. Bone formation at the cutting site was satisfactory, and the union of the bone ends indicated good healing. After two years of follow-up, the patient had essentially returned to normal.

CONCLUSION

We successfully applied the Ilizarov technique to treat ABC, reducing the financial burden of patients and the pain of multiple surgeries. In cases where significant bone defects occur, the Ilizarov technique has demonstrated satisfactory therapeutic outcomes.

Adipose-derived stem cells and knee osteoarthritis: New perspectives, old concerns

In this editorial, we comment on the paper by Muthu et al published in the recent issue of the journal. This editorial review focusses on the use of adipose-derived stem cells (ADSCs) in knee osteoarthritis treatment. We discuss the differences between the stromal vascular fraction and microfragmented adipose tissue and highlight the results of clinical studies comparing both treatments and the use of hyaluronic acid, platelet-rich plasma, and bone marrow aspirate concentrate. The use of expanded ADSCs is also discussed; moreover, concerns regarding treatment with ADSCs, particularly the heterogeneity of published studies and the need to standardize protocols to explore clinical potential is explored.

Metagenomic next-generation sequencing may assist diagnosis of osteomyelitis caused by Mycobacterium houstonense: A case report

BACKGROUND

Mycobacterium houstonense (M. houstonense) belongs to the nontuberculous mycobacterium group. Infection caused by M. houstonense is prone to recurrence.

CASE SUMMARY

We present a patient who was diagnosed with osteomyelitis caused by M. houstonense and treated with a combination of cefoxitin, and amikacin combined with linezolid.

CONCLUSION

The emergence of metagenomic next-generation sequencing (NGS) has brought new hope for the diagnosis and treatment of listeria meningitis. NGS can analyze a large number of nucleic acid sequences in a short time and quickly determine the pathogen species in the sample. Compared with traditional cerebrospinal fluid culture, NGS can greatly shorten the diagnosis time and provide strong support for the timely treatment of patients. Regarding treatment, NGS can also play an important role. Rapid and accurate diagnosis can enable patients to start targeted treatment as soon as possible and improve the treatment effect. At the same time, by monitoring the changes in pathogen resistance, the treatment plan can be adjusted in time to avoid treatment failure.

Impacts of mesenchymal stem cells and hyaluronic acid on inflammatory indicators and antioxidant defense in experimental ankle osteoarthritis

BACKGROUND

No effective treatment guarantees full recovery from osteoarthritis (OA), and few therapies have disadvantages.

AIM

To determine if bone marrow mesenchymal stem cells (BMMSCs) and hyaluronic acid (HA) treat ankle OA in Wistar rats.

METHODS

BMMSCs were characterized using flow cytometry with detection of surface markers [cluster of differentiation 90 (CD90), CD105, CD34, and CD45]. Fifty male Wistar rats were divided into five groups of 10 rats each: Group I, saline into the right tibiotarsal joint for 2 days; Group II, monosodium iodate (MIA) into the same joint; Groups III, MIA + BMMSCs; Group IV, MIA + HA; and Group V, MIA + BMMSCs + HA. BMMSCs (1 × 106 cells/rat), HA (75 µg/rat), and BMMSCs (1 × 106 cells/rat) alongside HA (75 µg/rat) were injected intra-articularly into the tibiotarsal joint of the right hind leg at the end of weeks 2, 3, and 4 after the MIA injection.

RESULTS

The elevated right hind leg circumference values in the paw and arthritis clinical score of osteoarthritic rats were significantly ameliorated at weeks 4, 5, and 6. Lipid peroxide significantly increased in the serum of osteoarthritic rats, whereas reduced serum glutathione and glutathione transferase levels were decreased. BMMSCs and HA significantly improved OA. The significantly elevated ankle matrix metalloproteinase 13 (MMP-13) mRNA and transforming growth factor beta 1 (TGF-β1) protein expression, and tumor necrosis factor alpha (TNF-α) and interleukin-17 (IL-17) serum levels in osteoarthritic rats were significantly downregulated by BMMSCs and HA. The effects of BMMSCs and HA on serum TNF-α and IL-17 were more potent than their combination. The lowered serum IL-4 levels in osteoarthritic rats were significantly upregulated by BMMSCs and HA. Additionally, BMMSCs and HA caused a steady decrease in joint injury and cartilage degradation.

CONCLUSION

BMMSCs and/or HA have anti-arthritic effects mediated by antioxidant and anti-inflammatory effects on MIA-induced OA. MMP-13 and TGF-β1 expression improves BMMSCs and/or HA effects on OA in Wistar rats.

Cardiotoxicity concerns in total joint arthroplasty

This editorial examines the cardiotoxic effects of elevated metal concentrations in patients who received total joint arthroplasty, as detailed in the study of Brennan et al. The study findings reveal that elevated cobalt and titanium levels may affect the cardiac structure and function, providing crucial insights for clinical practice and research. This editorial suggests that the close monitoring of metal ion levels in patients undergoing arthroplasty is necessary to reduce cardiovascular risk.

Insights and implications from the study on meniscus reconstruction using tendon autograft

This letter addresses the recent study by Zhu et al on the predictive factors for coronal and sagittal graft extrusion length following medial meniscus reconstruction using tendon autografts. The study provides valuable insights into the importance of preoperative joint space width and tunnel positioning as predictors of graft extrusion. Specifically, it found strong correlations between preoperative joint space width and medial, posterior, and mean graft extrusion at both 1 week and 8 months post-operation. Additionally, tunnel edge distance at 1 week post-operation correlated with anterior and posterior graft extrusion. These findings offer critical guidance for improving surgical outcomes. However, the letter highlights the need for further research with larger sample sizes and comparative studies involving different graft types to strengthen these findings and broaden their applicability in clinical settings. The study's contributions to understanding meniscus reconstruction using tendon autografts are acknowledged, along with suggestions for future research directions.

Predictive factors for coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction

BACKGROUND

Meniscus extrusion occurs in most elderly individuals and most patients after meniscus allograft transplantation. The risk factors and correlative factors of meniscus extrusion have been extensively studied. However, for using tendon autograft for meniscus reconstruction, both graft type and surgical method are different from those in previous studies on meniscus extrusion.

AIM

To identify predictive factors for coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction.

METHODS

Ten patients who underwent medial meniscus reconstruction with tendon autograft were selected for this retrospective observational study. The graft extrusions and potential factors were measured and correlation and regression analyses were performed to analyze their relationships.

RESULTS

The medial graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference, preoperative Kellgren-Lawrence grade, preoperative relative joint space width, and preoperative bilateral medial edge incline angle difference. The anterior graft correlated with the anterior tunnel edge distance at 1 week after operation. The posterior graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference, preoperative relative joint space width, and posterior tunnel edge distance at 1 week after operation. The mean graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference and preoperative relative joint space width. The preoperative joint space width and anterior and posterior tunnel edge distance at 1 week can be used to predict the medial, anterior, posterior, and mean graft extrusion length.

CONCLUSION

The preoperative joint space width and tunnel position can be used to predict the coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction.